Supportive care for patients with breast cancer by using an interactive app during neoadjuvant chemotherapy : a randomized controlled trial

Background: Patients with breast cancer undergoing neoadjuvant chemotherapy are often treated as outpatients and experience several distressing symptoms and concerns over a long period, which must be managed at home. Routine use of patient reported outcomes facilitates communication with the healthcare of what needs the patient may have. To support patients with cancer during treatment, the use of mHealth has shown promising results in reducing symptoms and improving quality of life.

Aim: To evaluate how an interactive app for reporting and managing symptoms provides supportive care in patients with breast cancer during neoadjuvant chemotherapy.

Methods: Through the app patients report symptoms daily as well as write free text messages. The reports are monitored and responded to by a contact nurse at the clinic. Further, the patients have access to self-care advice and can view their reported symptoms in graphs. This randomized controlled trial was conducted according to the Medical Research Council’s framework for complex interventions. In Study I, the patients were randomized to an intervention group (n = 74), who used the app during treatment in combination with standard care, and to a control group (n = 75), who received standard care alone. Both groups answered questionnaires regarding symptoms and healthrelated quality of life before start of treatment and two weeks after end of treatment, to evaluate if the intervention had any effects on the patients’ symptoms and health-related quality of life. Study II investigated the patients’ engagement in using the app. Logged data from the patient’s app usage (n = 74) and predictors of usage were analyzed. Telephone interviews were conducted with the patients about how they perceived using the app during treatment. In Study III, face-to-face interviews were conducted three months after end of neoadjuvant chemotherapy with patients from both groups (n = 40) about perceptions of care during treatment with or without using the app.

Results: In Study I, patients who used the app during treatment perceived less prevalence of symptoms and symptom distress and better emotional functioning two weeks after end of treatment compared with the patients in the control group. In Study II, the adherence to reporting in the app was 83%. The components included in the app, such as self-care advice and graphs, were used by most of the patients. Higher age predicted fewer free text messages sent. The app was considered easy to use with a relevant content, which facilitated support for symptom management and own monitoring of symptoms as well as having a close, continuous, and interactive contact with the contact nurse. In Study III, results showed that most of the patients, whether they had used the app or not, were satisfied with the care during the treatment. The patients who had used the app perceived it as an added value for support as they were provided easy access to information and communication regarding experienced symptoms with the contact nurse. Moreover, Interaktor facilitated performing self-care by using the self-care advice and promoted own participation in care.

Conclusions: This thesis shows that patients with breast cancer can receive supportive care by using an app such as Interaktor during neoadjuvant chemotherapy. By facilitating interaction and communication with the contact nurse, symptoms can be identified and managed in a timely manner as well as enhancing patients’ participation in their own care.

List of scientific papers

I. Fjell, M., Langius-Eklöf, A., Nilsson, M., Wengström, Y., Sundberg, K. (2020). Reduced symptom burden with the support of an interactive app during neoadjuvant chemotherapy for breast cancer – a randomized controlled trial. The Breast. 51, 85-93.
https://doi.org/10.1016/j.breast.2020.03.004

II. Crafoord, M. T.*, Fjell, M.*, Sundberg, K., Nilsson, M., Langius-Eklöf, A. (2020). Engagement in an interactive app for symptom self-management during treatment in patients with breast or prostate cancer: mixed methods study. Journal of Medical Internet Research. 22, e17058. *Equal contributors.
https://doi.org/10.2196/17058

III. Fjell, M., Langius-Eklöf, A., Nilsson, M., Sundberg, K. (2020). Patient perceptions of care with or without the support of an interactive app during neoadjuvant chemotherapy for breast cancer. [Manuscript]